Cor Vasa 2022, 64(5):499-503 | DOI: 10.33678/cor.2022.055

Electrophysiological findings after bilateral thoracoscopic atrial fibrillation ablation using irrigated bipolar radiofrequency energy - a pilot study

Tomáš Skála^a, Vlastimil Černíček^b, Ondřej Moravec^a, Marek Vícha^a, Petr Šantavý^c, Andrea Steriovský^c, Jitka Skálová^d, Olga Klementová^d, Miloš Táborský^a

^a Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc

^b Baťa Regional Hospital, Zlín

^c Department of Cardiac Surgery, University Hospital Olomouc, Olomouc

^d Department of Anesthesiology and Resuscitation, University Hospital Olomouc, Olomouc

Background: Thoracoscopic atrial fibrillation ablation (TARAFS) using irrigated bipolar radiofrequency energy (Medtronic Cardioblate Gemini-S) should result in wide isolation of the pulmonary veins (PVs) and posterior left atrial (LA) wall (the box-lesion technique). Electrophysiological findings after this technique using this instrumentation are not known.

Methods and results: 22 patients with AF recurrence after bilateral TARAFS for persistent AF had a radiofrequency catheter ablation (CA) at least three months after TARAFS.

Results: Out of 22 patients, the box lesion was not completed in 15 (68.2%) patients. 12 had no endocardial signs of any prior ablation, 2 had right pulmonary PVs isolated and 1 had left PVs isolated. At the end of CA, box lesion was finished in all 15 patients and AF non-inducibility was achieved in 18 patients.

Conclusion: In a considerable number of patients with AF recurrence after TARAFS box lesion is not finished and no signs of prior ablation to guide a touch-up catheter ablation are found on electroanatomical voltage map. In majority of patients, additional ablation beside box lesion is needed to achieve AF non-inducibility.

Keywords: Box lesion, Hybrid ablation, Persistent atrial fibrillation, Thoracoscopic ablation, Voltage map

Received: March 21, 2022; Revised: May 2, 2022; Accepted: May 12, 2022; Prepublished online: August 22, 2022; Published: November 1, 2022  Show citation